Dhat Syndrome: Epidemiology, Risk Factors, Comorbidities, Diagnosis, Treatment, and Management

Evaluation of the efficacy of novel treatment strategy to treat Dhat syndrome: a pilot study

Background

Dhat Syndrome is difficult to treat due to the unwavering belief of the patients about the harmful effects of semen loss. We hypothesized that this belief can be overcome by objective demonstration of zero health benefit of zero semen loss using reversible anejaculation property of silodosin.

Aim

To prospectively evaluate the efficacy of objective demonstration of zero health benefits of zero semen loss as treatment strategy to alter the mental construct of the Dhat syndrome patients using a randomized double blind placebo controlled two arm switchover study design.

Methods

The patients with complaints of Dhat syndrome were recruited post-confirmation of the diagnosis by Dhat Syndrome Evaluation Questionnaire (DSEQ). After excluding participants based on exclusion criteria, participants’ anxiety and perceived physical fitness was assessed using Hamilton Anxiety Rating Scale (HARS) and Perceived Physical Fitness Scale (PPFS) respectively. They were randomized into two groups with Group 1 receiving placebo and Group 2 receiving silodosin 8 mg respectively with counseling being common for both. After 2 months, and a drug wash out period of 7 days, the participants were switched and interventions continued for another two months. In the end, Dhat symptomatology with DSEQ, anxiety with HARS and perceived physical fitness with PPFS were assessed and compared with initial assessment and discussed with the participants in a one to one session. Main outcome measure: The post-intervention change in Dhat Syndrome symptomatology in our study participants.

Results

A total of 32 adult males grouped as 1 (N = 18, mean age 28.9 ± 4.8 years) and 2 (N = 14, mean age 27.4 ± 4.3 years) participated in the study with none and 59% reporting semen loss while on silodosin and placebo respectively. The PPFS showed no statistically significant difference irrespective of the type of treatment in our participants and approximately 2/3rds of the participants reported relief from Dhat symptomatology and significant reduction in anxiety related to semen loss.

Clinical implications

Objective demonstration of zero health benefits of total prevention of semen loss to the patients of Dhat syndrome directly contradicts the unwavering belief about the harmful effects of semen loss in these patients thus altering their mental constructs.

Strengths and limitations

Prospective randomization design and objective demonstration of zero health benefits of zero semen loss are the strengths and the small sample size is the limitation of the study.

Conclusions

The alteration of the mental construct of the Dhat syndrome patients using novel treatment strategy was successful in majority of our study participants.

Dhat Syndrome: Unusual Manifestation in a Distinct Cultural Context

Dhat syndrome is a culture-bound syndrome that presents with concerns about semen loss. This is a case of a 38-year-old Indian male who was brought to our psychiatric emergency department in Dubai, United Arab Emirates due to concerns of dizziness, excessive worry, and preoccupation with health. He reported somatic symptoms of left lumbar pain and passage of small, white stones during urination a few weeks before presentation. Subsequently, he developed multiple other symptoms like palpitations, tremors, sweating, and a few fainting episodes among others. During the assessment, it was understood he believed he was losing semen and this was affecting him significantly. He also had a few other stressors in his personal life. He previously had similar symptoms and claimed that traditional treatments treated him, hence insisted on a traditional healer at this time. He was found to have an anxious mood on further examination and was diagnosed with Dhat syndrome. He was started on treatment with a benzodiazepine and an antidepressant. This case piqued our interest as it is a condition with a significant cultural basis which presented in a region outside the relevant cultural region. The symptoms the patient presented with and the concerns he was seeking treatment for were quite unusual and seemed a rare incidence in the Middle East region.

South Asian Endocrinology: Challenges and Concerns, Collaboration and Consolidation

The practice of endocrinology in South Asia poses many challenges but simultaneously offers unique opportunities. The population in this region is predisposed to diabetes and cardiovascular disease at a much lower body mass index compared to Caucasians. Dietary deficiencies, higher prevalence of infection and distinct environmental and genetic factors further complicate the presentation of endocrine disorders. Over the past few decades, important breakthroughs have been made to confront these challenges. Collaboration among the endocrine fraternity of the South Asian countries will help to consolidate these gains and pave the way forward for a healthier region.